The Diagnosis of Dental Caries in Conservative Dentistry and Endodontics
RUNGTA COLLEGE OF DENTAL SCIENCES & RESEARCH
TITLE OF THE TOPIC – DIAGNOSIS OF DENTAL CARIES
DEPARTMENT OF CONSERVATIVE DENTISTRY AND
ENDODONTICS
1
Specific learning Objectives
•
*Subtopic of importance
•
** Cognitive, Psychomotor or Affective
•
# Must know , Nice to know & Desire to know
( Table to be prepared as per the above format )
At the end of this presentation the learner is expected to know ;
2
CONTENT
•
Classification of dental caries
•
Questions
•
Take home message
•
references
C
L
A
SS
I
F
I
C
A
T
ION
OF
DENTAL
CARIES
1
.
BA
S
E
D
O
N
A
NA
T
O
M
I
CA
L
S
ITE
O
C
C
L
U
S
A
L
(
P
I
T
A
N
D
F
I
S
S
U
R
E
)
R
O
O
T
C
A
R
I
E
S
S
M
O
O
T
H
S
U
R
F
A
C
E
C
A
R
I
E
S
(
P
R
O
X
I
M
A
L
A
N
D
C
E
R
V
I
C
A
L
C
A
R
I
E
S
)
L
I
N
E
A
R
E
N
A
M
E
L
C
A
R
I
E
S
PIT AND FISSURE
CARIES
PIT AND FISSURE
CARIES of the
primary type
develops
in the
occlusal surface of molar and
premolar,in the
buccal and
lingual
surface of
the
molar and
in the
palatal surface of
the maxillary
incisors.
Shape, morphological variation and depth of pit
and
fissures contributes
to
their high
susceptibility to
caries.
Enamel
in the extreme
depth
is
very
thin
or
occasionally absent and thus
allows
the exposure
of
dentin.
Pit
and fissures
affected
by early caries
may
appear
brown
or black and
will
feel slightly soft and ‘catch’ a fine explorer
point.
Entry
site
may
appear
much
smaller than
actual
lesion,
making
clinical
diagnosis
difficult.
Carious lesion of
pits
and
fissures
develop from attack on their
walls.
In
cross section, the gross appearance of
pit
and
fissure
lesion is
inverted
V
with
a
narrow entrance and
a
progressively
wider
area of involvement
closer
to the
DEJ.
MORPHOLOGY
OF
FISSURES
NANGO
(1960):Based on
the alphabetical
description of shape– 4
types
V&U
type: self cleansing and
somewhat
caries
resistant
U
type:
narrow
slit like
opening
with
a larger base as
it extend towards
DEJ
K
type: also
very susceptible
to
caries
Smooth surface
caries
Less favorable
site for
plaque attachment, usually attaches on the
smooth surface
that
are near
the
gingiva or are under
proximal
contact..
In very young patients
the gingival
papilla
completely
fills
the
interproximal
space under a
proximal
contact and
is
termed as col.
Also
crevicular spaces
in
them are less
favorable habitats for
s.mutans.
Consequently
proximal caries is
less
lightly to
develop
where
this
favorable soft tissue
architecture
exists
.
The
proximal surfaces are particularly susceptible
to
caries due
to
extra
shelter provided
to
resident plaque
owing
to
the
proximal contact area
immediately occlusal to plaque.
Lesion
have
a broad area of origin and a conical, or pointed
extension
towards
DEJ.
V shape
with
apex directed
towards DEJ.
After
caries penetrate
the DEJ
softening of dentin spread rapidly
and
pulpally
Linear enamel
caries
•
Linear
enamel caries
(
odontoclasia
)
is seen
to
occur in
the
region of the
neonatal line
of the maxillary anterior teeth.
•
The
line,
which represent
a
metabolic defect such as hypocalcemia or
trauma
of birth,
may
predispose
to
caries,
leading
to
gross destruction
of
the
labial
surface of the
teeth.
•
Morphological aspects of this type of caries are atypical and results in
gross destruction of the
labial
surfaces incisor
teeth
ROOT SURFACE
CARIES
The proximal
root surface,
particularly near the
cervical
line, often is
unaffected
by
the
action
of hygiene
procedures, such as
flossing,
because it
may
have
concave
anatomic
surface contours
(fluting)
and
occasional roughness at
the termination
of
the enamel.
These conditions, when coupled with
exposure
to the
oral
environment
(as
a result of
gingival
recession
),
favor
the
formation
of mature,
caries-producing plaque and
proximal
root-surface caries.
Root-surface caries
is
more
common
in older
patients
.
Caries
originating
on
the
root
is
alarming
because
1.
it has a
comparatively
rapid
progression
2.
it
is
often
asymptomatic
3.
it is closer
to the
pulp
4, it is
more difficult to
restore
The root surface
is refer the
enamel
and readily allows
plaque
formation
in the
absence
of
good oral
hygiene.
The cementum covering
the
root
surface is
extremely
thin
and provides
little
resistance
to caries attack.
Root caries lesions have less
well-defined
margins, tend
to
be U-shaped
in
cross sections, and progress more
rapidly
because
of the
lack of
protection from
and
enamel
covering.
2.BASED
ON
P
ROGR
ESS
I
O
N
ACUTE
CARIES
CHRONIC
CARIES
ARRESTED
CARIES
ACUTE
CARIES
Acute
caries is
a
rapid
process involving a
large
number
of
teeth.
These lesions are
lighter
colored
than
the other
types, being light brown
or grey, and
their
caseous consistency
makes
the
excavation
difficult.
Pulp exposures
and
sensitive teeth
are
often observed
in
patients
with
acute
caries.
It
has been suggested
that saliva
does not
easily penetrate
the small
opening
to
the
carious
lesion, so
there
are
little opportunity
for
buffering
or
neutralizaton
CHRONIC
CARIES
These lesions are usually of
long-standing
involvement,
affect
a
fewer
number
of
teeth, and are smaller than acute caries.
Pain is
not a common
feature
because of protection afforded
to
the pulp by secondary
dentin
The decalcified dentin is dark
brown
and
leathery.
Pulp prognosis is hopeful in that
the
deepest of lesions
usually
requires only prophylactic capping and protective bases.
The lesions range
in
depth and include those that
have
just
penetrated
the
enamel.
ARRESTED
CARIES
Caries which
becomes
stationary or static and does
no
t
show
any tendency for
further progression
Both deciduous and permanent
affected
With the shift
in the
oral conditions, even advanced
lesions
may
become
arrested
.
Arrested caries involving dentin shows
a marked
brown
pigmentation and induration of the lesion [the
so
called
‘eburnation of
dentin
’]
Sclerosis
of
dentinal tubules and secondary dentin
formation
commonly
occur
Exclusively
seen in
caries
of
occlusal surface
with
large
open
cavity
in
which
there is lack of
food
retention
Also on the
proximal
surfaces of tooth
in
cases
in
which
the
adjacent
approximating
tooth has
been
extracted
3.BASED
ON
VIRGINITY
Of
LESION
I
N
I
T
I
A
L
/
P
R
I
M
A
RY
RECURRENT/SECONDARY
PRIMARY
CARIES(INITIAL)
A primary caries
is
one
in which the
lesion
constitutes the initial
attack on
the tooth surface.
The
designation
of
primary
is
based on
the
initial
location
of
the
lesion on
the
surface
rather than the extent
of
damage.
SECONDARY
CARIES
(RECURRENT)
This
type
of caries is observed around the edges
and
under
restorations
.
The
common locations of secondary caries are the rough or
overhanging margin and fracture place in all locations of the
mouth.
It may
be result
of
poor adaptation
of a
restoration,
which
allows
for
a
marginal leakage, or
it may
be
due to
inadequate
extension
of
the restoration.
In
addition caries
may
remain if there has not been complete
excavation
of the original lesion,
which
later
may
appear as
a
residual or recurrent
caries.
4. BASED ON
EXTENT
OF
CAR
I
E
S
I
N
C
I
P
I
E
N
T
C
A
R
I
E
S
C
A
V
I
T
A
T
I
O
N
O
C
C
U
L
T
C
A
R
I
E
S
INCIPIENT
CARIES
The
early caries lesion, best seen on the smooth surface of teeth,
is visible as a
‘
white
spot
’.
Histologically
the
lesion has an apparently intact surface layer
overlying subsurface demineralization.
Significantly
may
such lesion
can undergo remineralization
and thus
the
lesion
is not
an indication
for
restorative
treatment
These
white
spot
lesion
may
be confused
initially
with
white
developmental
defects of
enamel
formation,
which
can be
differentiated
by
their position away from the gingival
margin],
their
shape
[unrelated to
plaque accumulation] and
their
symmetry
[they
usually
affect the contralateral
tooth].
Also on wetting the
caries
lesion
disappear
while
the
developmental defect
persist
It
is
believed
that bite
wing
and OPG radiographs along
with noninvasive
adjuncts like fiber optic transillumination (FOTI),laser luminescence,
electrical resistance method
(ERM)
are
used
for diagnosis these occlusal
lesions.
These
lesion
are not associated
with
microorganisms different
to
those
found in other carious
lesion.
These carious lesion
seem to
increase
with increasing
age.
Occult carious lesion are
usually
seen
with
low caries rate
which
is
suggestive
of
increase fluid
exposure.
It
is believed that
increased fluid exposure encourages
remineralization
and slow
down
progress of
the
caries in the pit and
fissure
enamel
while the
cavitations continues in dentine, and
the
lesions
become
masked by a relatively intact
enamel
surface.
These hidden lesions are called
as
fluoride
bombs
or fluoride
syndrome.
Recently
it
is seen that occult caries
may
have its origin as pre-
eruptive defects
which
are detectable only
with
the use
of
radiographs.
Once
it reaches the
dentinoenamel junction,
the
caries process has the
potential
to
spread
to the
pulp
along
the
dentinal
tubules and also spread in
lateral
direction.
Thus
some
amount of
sensitivity
may
be
associated with this
type
of
lesion.
This
may
be
generally
accompanied by
cavitation
5.Based
on
tissue
involvement
1.
I
n
i
t
i
a
l
c
a
r
i
e
s
2.
S
u
p
e
r
f
i
c
i
a
l
c
a
r
i
e
s
3.
M
o
d
e
r
a
t
e
c
a
r
i
e
s
4.
D
e
e
p
c
a
r
i
e
s
5.
D
e
e
p
c
o
m
p
l
i
c
a
t
e
d
c
a
r
i
e
s
Dental caries
can
be divided into
4
or
5
I
n
i
t
i
a
l
c
a
r
i
e
s
:
D
e
m
i
n
e
r
a
l
i
z
a
t
i
o
n
w
i
t
h
o
u
t
s
t
r
u
c
t
u
r
a
l
d
e
f
e
c
t
.
T
h
i
s
s
t
a
g
e
c
a
n
b
e
r
e
v
e
r
s
e
d
b
y
f
l
u
o
r
i
d
a
t
i
o
n
a
n
d
e
n
h
a
n
c
e
d
m
o
u
t
h
h
y
g
i
e
n
e
S
u
p
e
r
f
i
c
i
a
l
c
a
r
i
e
s
(
C
a
r
i
e
s
s
u
p
e
r
f
i
c
i
a
l
i
s
)
:
E
n
a
m
e
l
c
a
r
i
e
s
,
w
e
d
g
e
-
s
h
a
p
e
d
s
t
r
u
c
t
u
r
a
l
d
e
f
e
c
t
.
C
a
r
i
e
s
h
a
s
a
f
f
e
c
t
e
d
t
h
e
e
n
a
m
e
l
l
a
y
e
r
,
b
u
t
h
a
s
n
o
t
y
e
t
p
e
n
e
t
r
a
t
e
d
t
h
e
d
e
n
t
i
n
.
3.
M
o
d
e
r
a
t
e
c
a
r
i
e
s
(
C
a
r
i
e
s
m
e
d
i
a
)
:
D
e
n
t
i
n
c
a
r
i
e
s
.
E
x
t
e
n
s
i
v
e
s
t
r
u
c
t
u
r
a
l
d
e
f
e
c
t
.
C
a
r
i
e
s
h
a
s
p
e
n
e
t
r
a
t
e
d
u
p
t
o
t
h
e
d
e
n
t
i
n
a
n
d
s
p
r
e
a
d
s
t
w
o
-
d
i
m
e
n
s
i
o
n
a
l
l
y
b
e
n
e
a
t
h
t
h
e
e
n
a
m
e
l
d
e
f
e
c
t
w
h
e
r
e
t
h
e
d
e
n
t
i
n
o
f
f
e
r
s
l
i
t
t
l
e
r
e
s
i
s
t
a
n
c
e
.
4.
D
e
e
p
c
a
r
i
e
s
(
C
a
r
i
e
s
p
r
o
f
u
n
d
a
)
:
D
e
e
p
s
t
r
u
c
t
u
r
a
l
d
e
f
e
c
t
.
C
a
r
i
e
s
h
a
s
p
e
n
e
t
r
a
t
e
d
u
p
t
o
t
h
e
d
e
n
t
i
n
l
a
y
e
r
s
o
f
t
h
e
t
o
o
t
h
c
l
o
s
e
t
o
t
h
e
p
u
l
p
.
5.
D
e
e
p
c
o
m
p
l
i
c
a
t
e
d
c
a
r
i
e
s
(
C
a
r
i
e
s
p
r
o
f
u
n
d
a
c
o
m
p
l
i
c
a
t
a
)
:
C
a
r
i
e
s
h
a
s
l
e
d
t
o
t
h
e
o
p
e
n
i
n
g
o
f
t
h
e
p
u
l
p
c
a
v
i
t
y
(
p
u
l
p
a
a
p
e
r
t
a
o
r
o
p
e
n
p
u
l
p
)
.
TAKE HOME MESSAGE
Dental caries is the most common chronic disease in the world
It is a multifactorial disease
Tetrad of dental caries include- host, substrate ,flora,time
Questions
•
Define dental caries
•
GV Black classification
•
theories of dental caries
REFRENCES
•
John I. ingle,DDS,MSD Endodontics Fifth edition
•
M.A.Marzouk,A.L.Simonton,R.D.Gross Modern Theory and Practice
Operative Dentistry.
•
Shaffers Textbook Of Oral Pathology and Medicine
THANK YOU
37
This presentation covers the classification of dental caries based on anatomical site, focusing on pit and fissure caries. It discusses the development, appearance, and diagnosis of pit and fissure caries, as well as the morphology of fissures. Learners will gain knowledge on the specific learning objectives related to the diagnosis of dental caries. Visual aids and detailed information enhance the understanding of this important topic in dentistry.
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RUNGTA COLLEGE OF DENTAL SCIENCES & RESEARCH TITLE OF THE TOPIC DIAGNOSIS OF DENTAL CARIES DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS 1
Specific learning Objectives At the end of this presentation the learner is expected to know ; Core areas* Domain ** Category # classification Cognitive Must know *Subtopic of importance ** Cognitive, Psychomotor or Affective # Must know , Nice to know & Desire to know ( Table to be prepared as per the above format ) 2
CONTENT Classification of dental caries Questions Take home message references
CLASSIFICATION OF DENTAL CARIES
1.BASED ON ANATOMICAL SITE OCCLUSAL (PIT AND FISSURE) SMOOTH SURFACE CARIES (PROXIMAL AND CERVICAL CARIES) LINEAR ENAMEL CARIES ROOT CARIES
PIT AND FISSURE CARIES PIT AND FISSURE CARIES of the primary type develops in the occlusal surface of molar and premolar,in the buccal and lingual surface of the molar and in the palatal surface of the maxillary incisors. Shape, morphological variation and depth of pit and fissures contributes to their high susceptibility to caries. Enamel in the extreme depth is very thin or occasionally absent and thus allows the exposure of dentin.
Pit and fissures affected by early caries may appear brown or black and will feel slightly soft and catch a fine explorer point. Entry site may appear much smaller than actual lesion, making clinical diagnosis difficult. Carious lesion of pits and fissures develop from attack on their walls. In cross section, the gross appearance of pit and fissure lesion is inverted V with a narrow entrance and a progressively wider area of involvement closer to the DEJ.
MORPHOLOGY OF FISSURES NANGO (1960):Based on the alphabetical description of shape 4 types V&U type: self cleansing and somewhat caries resistant U type: narrow slit like opening with a larger base as it extend towards DEJ K type: also very susceptible to caries
Smooth surface caries Less favorable site for plaque attachment, usually attaches on the smooth surface that are near the gingiva or are under proximal contact.. In very young patients the gingival papilla completely fills the interproximal space under a proximal contact and is termed as col. Also crevicular spaces in them are less favorable habitats for s.mutans. Consequently proximal caries is less lightly to develop where this favorable soft tissue architecture exists.
The proximal surfaces are particularly susceptible to caries due to extra shelter provided to resident plaque owing to the proximal contact area immediately occlusal to plaque. Lesion have a broad area of origin and a conical, or pointed extension towards DEJ. V shape with apex directed towards DEJ. After caries penetrate the DEJ softening of dentin spread rapidly and pulpally
Linear enamel caries Linear enamel caries ( odontoclasia ) is seen to occur in the region of the neonatal line of the maxillary anterior teeth. The line, which represent a metabolic defect such as hypocalcemia or trauma of birth, may predispose to caries, leading to gross destruction of the labial surface of the teeth. Morphological aspects of this type of caries are atypical and results in gross destruction of the labial surfaces incisor teeth
ROOT SURFACE CARIES The proximal root surface, particularly near the cervical line, often is unaffected by the action of hygiene procedures, such as flossing, because it may have concave anatomic surface contours (fluting) and occasional roughness at the termination of the enamel. These conditions, when coupled with exposure to the oral environment (as a result of gingival recession), favor of mature, caries-producing plaque and proximal root-surface caries. the formation Root-surface caries is more common in older patients. Caries originating on the root is alarming because 1. it has a comparatively 2. it is often asymptomatic 3. it is closer to the pulp 4, it is more difficult to restore rapidprogression
The root surface is refer the enamel and readily allows plaque formation in the absence of good oral hygiene. The cementum covering the root surface is extremely thin and provides littleresistance to caries attack. Root caries lesions have less well-defined margins, tend to be U-shaped in cross sections, and progress more rapidly because of the lack of protection from and enamel covering.
2.BASED ON PROGRESSION ACUTE CARIES ARRESTED CARIES CHRONIC CARIES
ACUTE CARIES Acute caries is a rapid process involving a large number of teeth. These lesions are lighter colored than the other types, being light brown or grey, and their caseous consistency makes the excavation difficult. Pulp exposures and sensitive teeth are often observed in patients with acute caries. It has been suggested that saliva does not easily penetrate the small opening to the carious lesion, so there are little opportunity for buffering or neutralizaton
CHRONIC CARIES These lesions are usually of long-standing involvement, affect a fewer number of teeth, and are smaller than acute caries. Pain is not a common feature because of protection afforded to the pulp by secondary dentin The decalcified dentin is dark brown and leathery. Pulp prognosis is hopeful in that the deepest of lesions usually requires only prophylactic capping and protective bases. The lesions range in depth and include those that have just penetrated the enamel.
ARRESTED CARIES Caries which becomes stationary or static and does not show any tendency for further progression Both deciduous and permanent affected With the shift in the oral conditions, even advanced lesions may become arrested . Arrested caries involving dentin shows a marked brown pigmentation and induration of the lesion [the so called eburnation of dentin ] Sclerosis of dentinal tubules and secondary dentin formation commonly occur
Exclusively seen in caries of occlusal surface with large open cavity in which there is lack of food retention Also on the proximal surfaces of tooth in cases in which the adjacent approximating tooth has been extracted
3.BASED ON VIRGINITY Of LESION INITIAL/PRIMARY RECURRENT/SECONDARY
PRIMARY CARIES(INITIAL) A primary caries is one in which the lesion constitutes the initial attack on the tooth surface. The designation of primary is based on the initial location of the lesion on the surface rather than the extent of damage.
SECONDARY CARIES (RECURRENT) This type of caries is observed around the edges and under restorations. The common locations of secondary caries are the rough or overhanging margin and fracture place in all locations of the mouth. It may be result of poor adaptation of a restoration, which allows for a marginal leakage, or it may be due to inadequate extension of the restoration. In addition caries may remain if there has not been complete excavation of the original lesion, which later may appear as a residual or recurrent caries.
4. BASED ON EXTENT OF CARIES INCIPIENT CARIES CAVITATION OCCULT CARIES
INCIPIENTCARIES The early caries lesion, best seen on the smooth surface of teeth, is visible as a white spot . Histologically the lesion has an apparently intact surface layer overlying subsurface demineralization. Significantly may such lesion can undergo remineralization and thus the lesion is not an indication for restorative treatment
These white spot lesion may be confused initially with white developmental defects of enamel formation, which can be differentiated by their position away from the gingival margin], their shape [unrelated to plaque accumulation] and their symmetry [they usually affect the contralateral tooth]. Also on wetting the caries lesion disappear while the developmental defect persist
It is believed that bite wing and OPG radiographs along with noninvasive adjuncts like fiber optic transillumination (FOTI),laser luminescence, electrical resistance method (ERM) are used for diagnosis these occlusal lesions. These lesion are not associated with microorganisms different to those found in other carious lesion. These carious lesion seem to increase with increasing age. Occult carious lesion are usually seen with low caries rate which is suggestive of increase fluid exposure.
It is believed that increased fluid exposure encourages remineralization and slow down progress of the caries in the pit and fissure enamel while the cavitations continues in dentine, and the lesions become masked by a relatively intact enamel surface. These hidden lesions are called as fluoride bombs or fluoride syndrome. Recently it is seen that occult caries may have its origin as pre- eruptive defects which are detectable only with the use of radiographs.
Once it reaches the dentinoenamel junction, the caries process has the potential to spread to the pulp along the dentinal tubules and also spread in lateral direction. Thus some amount of sensitivity may be associated with this type of lesion. This may be generally accompanied by cavitation
5.Based involvement on tissue 1. Initial caries 2. Superficial caries 3. Moderate caries 4. Deep caries 5. Deep complicated caries
Dental caries can be divided into 4 or 5 Initial caries: Demineralization without structural defect. This stage can be reversed by fluoridation and enhanced mouth hygiene Superficial caries (Caries superficialis):Enamel caries, wedge- shaped structural defect. Caries has affected the enamel layer, but has not yet penetrated the dentin.
3. Moderate caries (Caries media): Dentin caries. Extensive structural defect. Caries has penetrated up to the dentin and spreads two- dimensionally beneath the enamel defect where the dentin offers little resistance. 4. Deep caries (Caries profunda): Deep structural defect. Caries has penetrated up to the dentin layers of the tooth close to the pulp. 5. Deep complicated caries (Caries profunda complicata) :Caries has led to the opening of the pulp cavity (pulpa aperta or open pulp).
TAKE HOME MESSAGE Dental caries is the most common chronic disease in the world It is a multifactorial disease Tetrad of dental caries include- host, substrate ,flora,time
Questions Define dental caries GV Black classification theories of dental caries
REFRENCES John I. ingle,DDS,MSD Endodontics Fifth edition M.A.Marzouk,A.L.Simonton,R.D.Gross Modern Theory and Practice Operative Dentistry. Shaffers Textbook Of Oral Pathology and Medicine
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